<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Is_agency')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-is_agency" class="form-control selectpicker" name="row[is_agency]">
                {foreach name="isAgencyList" item="vo"}
                    <option value="{$key}" {in name="key" value="1"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Platform_type')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-platform_type" class="form-control selectpicker" name="row[platform_type]">
                {foreach name="platformTypeList" item="vo"}
                    <option value="{$key}" {in name="key" value="1"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Parent_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-parent_id" data-rule="required" data-source="parent/index" class="form-control selectpage" name="row[parent_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user/user/index" data-field="nickname" class="form-control selectpage" name="row[user_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Goods_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-goods_id" data-rule="required" data-source="goods/index" class="form-control selectpage" name="row[goods_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shipping_contact')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shipping_contact" data-rule="required" class="form-control" name="row[shipping_contact]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shipping_phone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shipping_phone" data-rule="required" class="form-control" name="row[shipping_phone]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shipping_idcard')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shipping_idcard" data-rule="required" class="form-control" name="row[shipping_idcard]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shipping_province')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shipping_province" data-rule="required" class="form-control" name="row[shipping_province]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shipping_city')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class='control-relative'><input id="c-shipping_city" data-rule="required" class="form-control" data-toggle="city-picker" name="row[shipping_city]" type="text"></div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shipping_area')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shipping_area" data-rule="required" class="form-control" name="row[shipping_area]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shipping_address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shipping_address" data-rule="required" class="form-control" name="row[shipping_address]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Is_callback')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-is_callback" class="form-control selectpicker" name="row[is_callback]">
                {foreach name="isCallbackList" item="vo"}
                    <option value="{$key}" {in name="key" value="1"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_id" data-rule="required" data-source="order/index" class="form-control selectpage" name="row[order_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Phone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-phone" class="form-control" name="row[phone]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="orderStatusList" item="vo"}
            <label for="row[order_status]-{$key}"><input id="row[order_status]-{$key}" name="row[order_status]" type="radio" value="{$key}" {in name="key" value="3"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_status_text')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_status_text" class="form-control" name="row[order_status_text]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Rebate')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-rebate" class="form-control" step="0.01" name="row[rebate]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Channel')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-channel" class="form-control" name="row[channel]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Remark')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-remark" class="form-control" name="row[remark]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shipping_company_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shipping_company_name" class="form-control" name="row[shipping_company_name]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shipping_no')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shipping_no" class="form-control" name="row[shipping_no]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Is_recharged')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-is_recharged" class="form-control selectpicker" name="row[is_recharged]">
                {foreach name="isRechargedList" item="vo"}
                    <option value="{$key}" {in name="key" value="0"}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Callback_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-callback_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[callback_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_info_json')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <dl class="fieldlist" data-name="row[order_info_json]">
                <dd>
                    <ins>{:__('Key')}</ins>
                    <ins>{:__('Value')}</ins>
                </dd>
                <dd><a href="javascript:;" class="btn btn-sm btn-success btn-append"><i class="fa fa-plus"></i> {:__('Append')}</a></dd>
                <textarea name="row[order_info_json]" class="form-control hide" cols="30" rows="5"></textarea>
            </dl>


        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Jiesuan_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-jiesuan_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[jiesuan_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_rebate')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_rebate" class="form-control" step="0.01" name="row[user_rebate]" type="number" value="0.00">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Package_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-package_name" class="form-control" name="row[package_name]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Settlement_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-settlement_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[settlement_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Partnerid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-partnerId" class="form-control" name="row[partnerId]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lgtsid')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-lgtsId" class="form-control" name="row[lgtsId]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Actime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-actime" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[actime]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Image')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-image" class="form-control" size="50" name="row[image]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-image" class="btn btn-danger faupload" data-input-id="c-image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp,image/webp" data-multiple="false" data-preview-id="p-image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-image" class="btn btn-primary fachoose" data-input-id="c-image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-image"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-image"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Reason')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-reason" class="form-control" name="row[reason]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Audit_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-audit_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[audit_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Two_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-two_id" data-rule="required" data-source="two/index" class="form-control selectpage" name="row[two_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Audit_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-audit_status" data-rule="required" class="form-control" name="row[audit_status]" type="number" value="0">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Rebate_recover_msg')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-rebate_recover_msg" class="form-control" name="row[rebate_recover_msg]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Rebate_recover_money')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-rebate_recover_money" class="form-control" step="0.01" name="row[rebate_recover_money]" type="number" value="0.00">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Baoxiao_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="baoxiaoStatusList" item="vo"}
            <label for="row[baoxiao_status]-{$key}"><input id="row[baoxiao_status]-{$key}" name="row[baoxiao_status]" type="radio" value="{$key}" {in name="key" value="0"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Recover_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            
            <div class="radio">
            {foreach name="recoverStatusList" item="vo"}
            <label for="row[recover_status]-{$key}"><input id="row[recover_status]-{$key}" name="row[recover_status]" type="radio" value="{$key}" {in name="key" value="1"}checked{/in} /> {$vo}</label> 
            {/foreach}
            </div>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Recover_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-recover_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[recover_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Audit_upload_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-audit_upload_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[audit_upload_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Baoxiao_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-baoxiao_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[baoxiao_time]" type="text" value="{:date('Y-m-d H:i:s')}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
